the lived experiences of females in mid-adolescence who use social media in relation to self-harm

185 Pages·2015·2.62 MB·English

THE LIVED EXPERIENCES OF FEMALES IN MID-ADOLESCENCE
WHO USE SOCIAL MEDIA IN RELATION TO SELF-HARM

Lucy Brett-Taylor

A thesis submitted in partial fulfilment of the requirements of the University
of East London for the Professional Doctorate in Clinical Psychology
May 2015
Word count 27 968

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Table of Contents
ACKNOWLEDEMENTS ............................................................................................................... 5
ABSRACT ...................................................................................................................................... 5
1. INTRODUCTION ................................................................................................................... 6
1.1 The current context ..................................................................................................... 7
1.1.1 Media coverage of self-harm and social media................................................. 7
1.1.2 Current guidance ................................................................................................... 8
1.2 Literature search .......................................................................................................... 8
1.3 Self-harm ........................................................................................................................ 9
1.3.1 Definitions, functions and explanatory models of self-harm ............................ 9
1.3.2 Explanatory models of self-harm ....................................................................... 12
1.3.3 Who self-harms? .................................................................................................. 16
1.3.4 How self-harm is viewed? Dominant discourses ............................................ 18
1.4 ‘Borderline Personality Disorder’ .......................................................................... 19
1.4.1 Contested category ............................................................................................. 19
1.4.2 ‘Emerging Borderline Personality Disorder’ ..................................................... 20
1.5 Young people .............................................................................................................. 21
1.5.1 Development and neurobiology ......................................................................... 21
1.5.2 Young people and internet use .......................................................................... 22
1.6 Explanatory models of internet use...................................................................... 24
1.6.1 Disinhibition effects of interacting online .......................................................... 24
1.6.2 Possible functions and benefits of connecting online via technology .......... 25
1.7 Social media ................................................................................................................ 26
1.7.1 History, definition, types and who uses it ............................................................... 26
1.7.2 Why do people use social media? .......................................................................... 28
1.8 Relevant research ........................................................................................................... 30
1.8.1 Help or harm? ............................................................................................................. 30
1.8.2 Websites ...................................................................................................................... 31
1.8.3 Message boards ......................................................................................................... 33
1.8.4 Forums......................................................................................................................... 33
1.8.5 Internet search for self-harm .................................................................................... 34
1.8.6 You-tube ...................................................................................................................... 34
1.8.7 Social media ............................................................................................................... 35
1.9 Research hopes............................................................................................................... 35
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2. METHOD ............................................................................................................................... 36
2.1 Epistemology .............................................................................................................. 36
2.2 Why qualitative ........................................................................................................... 37
2.3 Choosing a methodology ........................................................................................ 38
2.4 What is IPA and why was it chosen ...................................................................... 38
2.5 The theoretical underpinnings of IPA .................................................................. 39
2.5.1 Phenomenology ................................................................................................... 39
2.5.2 Hermeneutics ....................................................................................................... 40
2.5.3 Idiography ............................................................................................................. 40
2.6 Reflexivity .................................................................................................................... 41
2.6.1 Reflexive statement ............................................................................................. 41
2.7 Ethics ............................................................................................................................ 42
2.8 Participants ................................................................................................................. 42
2.9 Data collection ............................................................................................................ 43
2.9.1 Recruitment strategy ........................................................................................... 43
2.9.2 Using interviews ................................................................................................... 44
2.9.3 Developing the interview schedule .................................................................... 44
2.9.4 Interview procedure ............................................................................................. 45
2.9.5 Informed consent ................................................................................................. 46
2.9.6 Confidentiality ....................................................................................................... 47
2.9.7 Ensuring safety and managing distress ........................................................... 47
2.10 Participant demographics ....................................................................................... 48
2.11 Analysis ........................................................................................................................ 49
2.12 Transcription............................................................................................................... 49
2.13 Analytic process ........................................................................................................ 49
2.13.1 Steps 1 and 2: Reading and re-reading ............................................................... 50
2.13.2 Stage 3: Developing emergent themes ................................................................ 50
2.13.3 Step 4: Searching for connections across emergent themes ........................... 50
2.13.4 Steps 5 and 6: Moving to the next case and looking for patterns across cases
................................................................................................................................................ 51
3. RESULTS ................................................................................................................................. 51
3.1 Overarching concept: Accessibility and mobility of social media .................... 51
3.2 Themes .............................................................................................................................. 52
3.2.1 Extension of everyday social media use ................................................................ 55
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3.2.2 Unexpected pitfalls .................................................................................................... 74
3.2.3 Expected benefits ...................................................................................................... 86
3.2.4 Misunderstandings of social media use: “unless you’re part of it, you wouldn’t
understand it” (Holly L: 915) ............................................................................................... 92
4. DISCUSSION ....................................................................................................................... 94
4.1 Summary of findings ...................................................................................................... 95
4.2 Situating the findings within the wider research context ............................... 96
4.2.1 Extension of everyday social media use ........................................................ 100
4.2.2 Unexpected pitfalls ............................................................................................ 105
4.2.3 Expected benefits .............................................................................................. 109
4.2.4 Misunderstanding of social media use ........................................................... 113
4.2.5 The role of gender ............................................................................................. 114
4.3 Critical review ........................................................................................................... 114
4.3.1 Strengths ............................................................................................................. 115
4.3.2 Limitations ........................................................................................................... 117
4.3.3 Reflection ............................................................................................................ 119
4.4 Implications and recommendations ................................................................... 120
4.4.1 Implications for future research ....................................................................... 120
4.4.2 Implications for clinical practice ....................................................................... 121
4.5 Final thought ............................................................................................................. 124
5. REFERENCES ................................................................................................................... 126
6. APPENDICIES ................................................................................................................... 148
Appendix A: UEL School of Psychology Research Ethics Sub-Committee ethical
approval ................................................................................................................................... 148
ETHICAL PRACTICE CHECKLIST (Professional Doctorates) .......................................... 149
RESEARCHER RISK ASSESSMENT CHECKLIST (BSc/MSc/MA) ................................. 150
Appendix B: NHS ethical approval letter ............................................................................ 153
Appendix C: Research and development approval .......................................................... 157
Appendix D: Information for clinicians ................................................................................ 159
Appendix E: Interview schedule .......................................................................................... 160
Appendix F: Information sheet for young people 12-15 ................................................... 162
Appendix G: Information sheet for young people 16-18 .................................................. 165
Appendix H: Information sheet for parents/carers ............................................................ 168
Appendix I: Assent form for young people 12-15.............................................................. 171
Appendix J: Consent for young people 16-18 ................................................................... 172
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Appendix K: Consent form for parents ............................................................................... 173
Appendix L: Extract of an annotated transcript ................................................................. 174
Appendix M: Audit of theme generation ................................................................................. 175
Appendix N: Theme map ...................................................................................................... 183
Appendix O: Extract from reflective journal ....................................................................... 184

ACKNOWLEDEMENTS

I would like to thank the young people who participated for taking the time to talk
to me and for their openness.
I would like to thank my supervisor Neil Rees for his support, guidance and
encouragement. Thank you to the DBT team clinicians for all their support with
planning, recruitment and feedback.
Thank you to Joe for his love, support, encouragement and stability throughout it
all. Laura, India and my course mates, thank you for your company in the library
and all your support. To dear Vera who is sadly missed. Thank you to my family
and friends for their love, support and encouragement too.
ABSRACT

Social media use and self-harm prevalence are both highest among young
people. Many explanatory models of self-harm have been proposed which are
helpful in understanding the functions self-harm serve. Social media is a relatively
new phenomenon requiring further research to increase understanding of the
psychological processes associated with its use. The connection between self-
harm and social media has received increased media attention in recent years
and is of clinical and social importance. The current study intended to increase
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the understanding of the connection between the two phenomena. Seven
females in mid-adolescence accessing a DBT service were interviewed about
their use of social media in relation to self-harm. Their interviews were analysed
using Interpretative Phenomenological Analysis (IPA). Data analysis led to the
identification of four super-ordinate themes, extension of everyday social media
use, unexpected pitfalls; expected benefits and misunderstandings: “unless
you’re part of it, you wouldn’t understand it”. The findings suggest that social
media is used in a number of ways in relation to self-harm and its use is
frequently an extension of the way young people use social media more
generally. This is influenced by many factors. Its use can lead to pitfalls and
benefits and navigating between the two is difficult and can be misunderstood by
others. The consideration of the findings in relation to the wider research context
has increased knowledge about the use of social media in relation to self-harm
within this population. Clinical implications and recommendations for future
research are suggested.
1. INTRODUCTION

How young people use social media in relation to self-harm and to what effect is
an important psychological, social and clinical issue. The use of social media
amongst young people in the general population and those who access mental
health services is widespread. Social media is a relatively new phenomenon in
need of further research to increase understanding about how it is interacted with
psychologically and to what effect. Young people use social media for a wide
variety of functions. These range from everyday connection with friends and
seeking support, which can have positive and supportive effects to others
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functions such as posting and viewing graphic images of self-harm, which can
have negative and harmful effects. Social media use has received a great deal of
media coverage. ‘Cyber self-harm’ has been identified as a new phenomenon
exacerbated by social media. Media attention has often focused on the tragic
stories of young people who have ended their lives and who used social media.
Understandable concern exists amongst clinicians who work with young people,
parents and wider society, including young people themselves, about the risks
associated with the role social media plays in young people’s lives. However,
there also exist many positive aspects to utilising social media. This research
aims to explore the views of young people who use social media to expand
understanding and knowledge about how and why they use it in relation to self-
harm and to what effect. The introduction will present the current context; explore
and introduce explanatory models and theories of self-harm and an associated
diagnostic label; consider perceptions of young people and the role of
development and neurobiology; connect these areas with and present
explanations for the use and effects of using technology and social media; and
review the relevant research.
1.1 The current context
1.1.1 Media coverage of self-harm and social media

Mass media portrayals of self-harm and social media have raised the profile of
the issue in recent years, for example; “a troubled ballerina, addicted to the
internet, shared photos of her own bleeding arms on grisly self-harm websites
before killing herself” (Radnedge, 2014, p.1). Tallulah Wilson, aged 15, spent
time on pages alleged to have promoted suicide posting pictures of her cutting
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herself on Tumblr. Her Mother said that Tallulah felt loved by 18,000 people
online. She sadly ended her life in 2012 by jumping in front of a train. Sasha
Stedman, aged 16, also became preoccupied by self-harm images on social
media sites and sadly died of what is described as an accidental heroin overdose
in 2014 (Moore-Bridger, 2014). Hannah Smith was 14 years old when she ended
her life in 2013 following harassment via the social media site Ask.fm, which on
closer investigation came mostly from her own computer. The death of Tallulah
Wilson and the association with social media led the government to intervene
demanding more vigilant monitoring of social media sites. In 2012, Tumblr
adhered to the governments demands (Tumblr, 2015; Hern, 2014).
1.1.2 Current guidance

The prominence and importance of the issue has led to the development of
recent clinical guidance on how to respond to self-harm in relation to social
media. The guidance states; “it is critical for professionals to include an
assessment of a young person’s digital life as part of clinical assessments,
especially when there are concerns about self-harm” (‘Managing self-harm in
young people’ recommendation 13, Royal College of Psychiatrists, RCP, 2014 p.
23). Lewis, Heath, Michal and Duggan (2012) devised assessment guidance. The
importance of understanding young peoples’ experiences of the differing content
of, and connections with other users of, social media has been highlighted (RCP,
2014).
1.2 Literature search

The searches utilised the relevant University of East London databases through
the Ebsco search engine. The databases used were PsychINFO, Academic
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search complete and Communication. The following search terms were used and
combined using AND in various groupings: self-harm, self-injury, self-injurious
behaviour, cutting, social media, social network, internet, adolescents, young
people, children and teens. In addition, relevant articles and books were included
from the reference lists of the retrieved articles.
1.3 Self-harm

1.3.1 Definitions, functions and explanatory models of self-harm

Various terms are used interchangeably to describe self-harm including non-
suicidal self-injury, self-mutilation and para-suicidal behaviour. Self-harm, the
commonly used term in England, has been defined as behaviour an individual
engages in which causes harm to their body and is performed without conscious
intent to end one’s life (Favazza, 1996). Self-harm can take various forms and
typically occurs in private (Adler & Adler, 2011; Duggan & Whitlock, 2012). Some
of the most common methods among young people include scratching, cutting,
punching or banging objects or one self, biting and burning (Duggan & Whitlock,
2012). Self-harm can be non-suicidal, occur with suicidal intent, culminate in
suicide or individuals may be ambivalent about whether they live or die (Hawton,
Saunders & O’Connor, 2012). Evidence shows an increased risk of suicide in
those with a history of self-harm (Hawton & Harris, 2007; Fortune, Stewart,
Yadav, & Hawton, 2007). In this study a broad definition of self-harm was
adopted in line with the service approach and Favazza’s (1996) definition. This
was to ensure inclusion with regard to methods of self-harm undertaken and to
maintain an exploratory position rather than imposing a restrictive definition.
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Psychological and medical research has conceptualised acts of self-harm as
unsuccessful suicide attempts, as an attempt to manage negative emotions and
cope with stress and a way to elicit care and attention (Whitlock, Powers &
Eckenrode, 2006; Jacobson & Gould, 2007). Such explanations apply to some
individuals however, functions are idiosyncratic, can change over time and can
differ for each individual in different contexts.
A wide variety of functions have been reported by individuals who self-harm and
relevant findings will now be outlined. 240 female participants from a community
sample reported self-harm served as self-punishment, enabled relaxation and
relieved feelings of depression and loneliness (Favazza & Contiero, 1989). Briere
and Gill (1998) found functions chosen by 70% or more of the female sample
again included self-punishment, stress and management, and in addition
distraction and enhanced feelings of self-control (Briere & Gill, 1998). Klonsky &
Muehlenkamp (2007) explained self-harm as a form of self-punishment for some
in response to feelings of low self-regard.
Self-harm has been conceptualised as a form of self-soothing behaviour; an
attempt to regulate unmanageable negative feelings felt prior to self-harming
which temporarily become feelings of calm and comfort afterwards (Klonsky &
Muehlenkamp, 2007). The physical pain is said to replace the emotional pain at
least for a time. Self-harming can release stress, pressure and emotional pain
and can be a form of communication to others therefore not only a secret
behaviour (Hawton et al., 2006; Cormack, 2014a). It is thought feelings of calm
and relief following self-harm could reinforce such behaviour and lead to a cycle
of emotional pain, self-harm and relief (Gratz, 2007).
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